ADHD symptoms in relation to internalizing and externalizing symptoms in children: the mediating role of sluggish cognitive tempo

Abstract

Objective: Although internalizing and externalizing disorders have received considerable attention among young population, the mechanisms that explain the relationships of internalization and externalization symptoms with attention deficit/hyperactivity disorder (ADHD) in children and adolescents are not well understood. Since sluggish cognitive tempo (SCT) symptoms had significant associations with ADHD, and internalization/externalization disorders, we examined whether SCT may mediate between ADHD symptoms and internalizing/externalizing problems during childhood.

Methods: We performed a retrospective chart-review of 95 children and adolescents (76 boys and 19 girls, aged 6–16) with ADHD. The severity of ADHD was evaluated by Turgay DSM-IV-Based Disruptive Behavioral Disorders Screening and Rating Scale (T-DSMIV-S) completed by teachers. Measures of SCT, internalisation and externalisation symptoms, social, thought, and attentional problems were based on the Teacher Report Form (TRF) that was completed by subjects’ primary teachers.

Results: The withdrawn scores were significantly correlated with SCT scores, social problems, and ADHD-inattention. There was an inverse correlation between withdrawn and ADHD-hyperactivity/impulsivity scores. The mediation test using bootstrapping method showed that the indirect coefficient for SCT was significant, after controlling of ADHD-inattention and social problems covariates, consistent with partial mediation.

Conclusion: Our results may demonstrate that while externalization symptoms were associated with hyperactivity/impulsivity symptoms of ADHD, the internalization symptoms were significantly related to SCT in youngs with ADHD. Specifically, although social withdrawal was significantly related to ADHD-inattention, this relationship was mediated by the severity of SCT.

Keywords:

• SCT
• ADHD
• internalization
• externalization

Disclosure statement

The authors declare no conflict of interests.

Additional information

Notes on contributors

Doga Sevincok

Doga Sevincok is already a research assistant at the Child and Adolescent Psychiatry Department of Aydin Adnan Menderes University. He studies on seperation anxiety, ADHD and sluggish cognitive tempo.

Hasan Can Ozbay

Hasan Can Ozbay is also a research assistant at the same department. He already studies on the relationship between ADHD and OCD.

Mutlu Muhammed Ozbek

Mutlu Muhammed Ozbek is a research assistant at the Child and Adolescent Psychiatry Department of Aydin Adnan Menderes University. He already deals with ADHD.

Mustafa Tolga Tunagur

Mustafa Tolga Tunagur is already a research assistant at the Child and Adolescent Psychiatry Department of Aydin Adnan Menderes University. He currently studies on the relationship between ADHD and neurological soft signs and neuropsychological performance.

Hatice Aksu

Hatice Aksu is an associated professor of Child and Adolescent Psychiatry and she is also the president of Child and Adolescent Psychiatry Department of Aydin Adnan Menderes University. She extensively studies on ADHD, autism spectrum disorders, and cognitive behavioral treatment in children and adolescents.